The monkeypox vaccine shows that we have learned very little about pandemic management despite COVID

We already knew, because we have learned it in the worst possible way, that there is nothing like an epidemic to bring to light all the problems that drag our health systems, our production structures and, ultimately, our societies themselves. What we did not expect is that, so soon after suffering from COVID, another epidemic was going to make it clear that we have learned almost nothing. But that’s how it is.

What other way is there to understand that, if we have 12 million doses of the monkeypox vaccine and the World Health Organization estimates that we need between four and ten to control the disease, vaccines are lacking everywhere?

The vaccine maze. The key to understand all this problem I gave it a few days ago Belén Tarrafetaa pharmaceutical company specializing in access to medicines, and has much to do with the tangle of bureaucratic, commercial and regulatory barriers that (although they may be essential to guarantee pharmacological safety in normal times) become a labyrinth with no way out when a disease puts us on the ropes.

As Tarrafeta explained, “Bavarian Nordic’s monkeypox vaccine is registered in 2019 under three different names: Jynneos in the US, Imvanex in the US, and Imvamune in Canada.” That’s where the unknowns begin: it is not clear why this disparity.

Although it is not clear what the reasons are (commercial, regulatory, or otherwise), it does seem essential because “the registration of a drug is done under a trade name, in such a way that the same drug with another trade name, manufactured in the same place, has no registration and therefore cannot be imported without ‘special permission'”.

a rat race. And we are not talking about a future. When the epidemic started, “Jynneos could hypothetically be used to prevent monkeypox in the United States, but Imvanex could not be used in that indication in the European Union.” However, the truth is that it had never been used to stop an epidemic (despite the fact that epidemics of the disease occurred recurrently in Africa). It was, so to speak, a vaccine for strategic purposes. It was there “just in case”.

So much so that the vaccine was stored in large containers (it was not in vials) and there are some “millions of doses that expired a few months ago.” This was due to the fact that, when monkeypox exploded, the manufacturer had put everything related to this vaccine on hold to produce others with higher priority. For this reason, when the regulatory issue is fine-tuned (in June in the US and in early July in Europe) there is a huge bottleneck.

For this reason, although the packaging plants have doubled, the batches that are coming out are vaccines that already had an owner. That’s what he does that New York has “received more than a hundred thousand doses, twice as many vaccines as the entire United Kingdom”. That is, countries around the world have returned to the “rat race” to have their vaccines and there is no general mechanism to rationalize the use of these vaccines.

More resources, worse results. As I said at the beginning, the lack of these mechanisms means that although we have enough vaccines to contain the epidemic, we are not going to contain it. What’s more, we are going to need many millions more doses than estimated to see how the epidemic continues to expand without being able to stop it. It is inevitable to stop in front of this nonsense and ask yourself, have we really not learned anything?

Image | Steven Cornfield